Provider Demographics
NPI:1841685682
Name:SHANGGUAN, SIYI (MD)
Entity type:Individual
Prefix:
First Name:SIYI
Middle Name:
Last Name:SHANGGUAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 STANIFORD ST STE 503
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-2517
Mailing Address - Country:US
Mailing Address - Phone:617-724-3874
Mailing Address - Fax:617-724-9428
Practice Address - Street 1:50 STANIFORD ST STE 503
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114
Practice Address - Country:US
Practice Address - Phone:617-724-3874
Practice Address - Fax:617-724-9428
Is Sole Proprietor?:No
Enumeration Date:2015-03-30
Last Update Date:2018-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA274509207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine